With the growing number of people testing positive for COVID19 infection, the number of contacts and other suspected cases is growing exponentially. The sheer number makes infection control difficult and therefore administrative quarantine a bad idea, experts opine.
Each positive case of COVID19 brings with it the mammothtask of contact tracing for the administration. An official involved in contactracing in Kashmir said each case involves quarantine for 20-30 contacts on anaverage. Currently, all of these contacts are quarantined in facilitiesadministered by Government, usually a hospital, a hostel or a governmentbuilding. Home quarantine, many subject experts believe, can be more effectiveand sustainable method of isolation of those who "might have been exposed" tothis highly contagious virus.
Social media is rife with concerns of facility sharing inthese facilities, a flaw that can lead to further spread of COVID19. An exampleof this came forth in Shopian, where a PHC was being used as quarantine for 11people, five of whom tested positive later. Many doctors believe these patientsgot infected in quarantine itself.
"Home isolation means we have a small unit of people in asetting where they can stay comfortably and where they will not be exposed to anew set of people," Prof S Saleem Khan, head department of preventive andcommunity medicine at Government Medical College said. This essentially meanscontainment at the micro level, he said. He said that taking people out oftheir homes and then admitting them to facilities where they will come incontact with other people, they had no prior contact with, is a "stark risk"."And then we may have individuals who are more at risk among those inquarantine. Their safety will be jeopardized," he said.
Prof Parvaiz Koul, head department of internal and pulmonarymedicine at SKIMS and an influenza expert, supported home quarantine as opposedto administrative quarantine for "conservation of resources". "If countrieslike Italy, USA and France can collapse under the pressure of COVID19 patients,we stand no chance," he said. He said that administrative quarantine was "notjust about identifying rooms" and putting rooms and people together. "It isalso about how we are going to manage those rooms, their logistics, safety ofpeople there," he said. "On top of it," he said, "let's accept that it's notpossible to provide bedding, food, and other essential basics to thousands andthousands that are going to get added to the list.
He however expressed fears that Kashmir may be "beyond thatphase". "There is a clear evidence that we have community transmission,limited, but definite," he said, adding that in that case, we need to adopt"cluster quarantine". "That should be our strategy in places where there aremore cases," he said.
Dr Naveed Nazir Shah, noted pulmonologist and in-charge ofCOVID19 response at CD Hospital, clearly advocated home quarantine forsuspected cases or even positive cases with mild symptoms. "However, we mayneed to take help of police and the community in ensuring that people underhome quarantine do not venture out and civil society can help in ensuring thatthose under quarantine have access to basic requirements," he said. "Inaddition," he said, "We also need their monitoring once a day by a medicalprofessionals."
Dr Aijaz A Koul, additional professor, medicine andinfectious diseases at SKIMS and clinician incharge for COVID19 at theInstitute, believes that administrative or home, it is the rules of thequarantine that would matter. He said that contacts of the positive case needto be "triaged". He however believes that casual contact and close contactdefinitions were too fluid and administration must ensure isolation ofsuspected cases from rest. "That means providing them individual facilitieswhere they do not end up exposing anyone else to risk of COVID19 infection," hesaid.
Divisional Commissioner Kashmir, Pandurang K Pole, said that"facility per se" was the problem as people live in groups in homes as well. Hesaid that it was the behavior of people that was necessitating such measures.He said that COVID19 was an evolving situation and therefore all strategies ofmanaging it were also evolving. He said home quarantine provision was alreadythere and people, when they complete administrative quarantine period arealready being sent for home quarantine. He however added that currently therewas a capacity of 12000 people in administrative quarantine and only 1500people were currently undergoing the two week stay in these facilities. He saidthat the Government was trying to ensure that each person has an individualroom to reduce chances of infection spread.
He further said that suspected cases were already beingsegregated from those that had tested negative and the positive cases werebeing treated in isolation of hospitals. He said there were two types ofpatients in hospital quarantines – contacts of positive cases and those whoattended a religious gathering in Delhi.